Category Archives: Health Care

Source: America’s Health Rankings

by James A. Bacon

Virginia has improved from 20th place last year to 15th place this year among the 50 states in America’s Health Rankings compiled by the United Health Foundation. The report cited the Commonwealth as one of three states that “made the largest improvements in the rankings since 2018.” (See the Virginia health profile here.)

Virginia strengths: a low crime rate, a low percentage of children in poverty, and high immunization coverage among children. Since 2012, smoking has decreased from 20.9% of adults to 14.9%. Air pollution has decreased, and so has infant mortality.

Virginia challenges: a low rate of mental health providers, low per capita public health funding, low meningococcal immunization among adolescents. Drug deaths are up, frequent mental distress has increased, and so has the rate of chlamydia.

Overall, the story is a positive one. To what does the Commonwealth owe this improvement? Continue reading →

Source: The Commonwealth Fund

by James A. Bacon

Mirroring national trends, Virginia healthcare markets are severely out of whack. The main difference is that here in the Old Dominion, they’re even more out of whack than they are for the country as a whole. In 2018, total out-of-pocket medical insurance costs for Virginia employees (employee contribution to premiums + deductible) amounted to $8,143 — 10.2% more than the national average.

That’s on top of what employers pay. According to the latest data compiled by the Commonwealth Fund, employers on average contribute $6,635 for single coverage and $19, 512 for family coverage. Add up the employer and employee share, and the cost of family coverage is equivalent to about $13.30 per hour in earnings for a full-time employee.

These costs have rapidly outpaced the general cost of living. As a percentage of median income, out-of-pocket costs have increased from 6.9% of median income to 10.7%.

Out-of-control medical insurance costs constitute a crisis for Virginia’s middle class. While the public policy debate in Richmond has focused almost exclusively on how to extend insurance coverage to the poor and working poor in the form of Medicaid expansion and Obamacare, nothing more than lip service has been given to the crisis for people who pay their own way. Continue reading →

by James A. Bacon

Having expanded Medicaid coverage for more than 325,000 Virginians, Governor Ralph Northam now has issued an executive order directing actions to increase the number of Virginians enrolled in “quality, affordable health care coverage.” Secretary of Health and Human Resources Daniel Carey will explore ways to expand Medicaid enrollment, reduce insurance premiums, increase transparency of insurance choices, and develop a “data-driven strategy to create efficiencies in coverage and improve outcomes” with a special focus on “vulnerable” populations.

We won’t know what these initiatives will cost the non-vulnerable (the vast majority of Virginians) until we see the proposals. But as Carey undertakes his inquiries, he and the Governor would be well advised to remember how much health care in the form of Medicaid is already costing the state.

State General Fund spending on Medicaid services has increased from $2.29 billion in Fiscal 2010 to $4.88 billion in Fiscal 2019, according to a recent update on state spending by the Joint Legislative Audit and Review Commission. That was an annual growth rate of 9% yearly, and it accounted for 39% of the growth of all General Fund spending, crowding out other priorities.

Meanwhile, the Kaiser Family Foundation has found that the average cost of employer-provided family health care coverage now exceeds $20,000 a year, with workers paying slightly more than $6,000. That’s a 5% increase from last year — and it doesn’t take into account steadily rising deductibles and co-pays. Middle-class Virginia households are caught in a triple whammy — supporting ever-inflating Medicaid costs, paying more for their own insurance, and paying more out-of-pocket. Continue reading →

Palliative care grades by state. Source: released 2019 “State-by-State Report Card on Access to Palliative Care in our Nation’s Hospitals”

by James A. Bacon

There are many ways to gauge the quality and cost-effectiveness of Virginia’s hospitals. One is to measure cost and efficiency. Another is to track mortality rates and re-admissions. Yet another is to rate patient satisfaction. You can find these metrics on the Virginia Health Information website.

But health care is a phenomenally complex business, and many other aspects of hospital care are measurable. In a recent press release, the Virginia Hospital & Healthcare Association (VHHA) pointed out, for instance, that Virginia is one of 20 states (and Washington, D.C.) to earn an “A” for palliative care, based on a study by the Center to Advance Palliative Care and the National Palliative Care Research Center.

What is palliative care? It is, according to the report, “specialized medical care for people living with a serious illness. It is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness.”

Having witnessed the lingering deaths of a step mother and father-in-law in recent years, I get it. The goal should not be to prolong life at any cost but to improve the quality of life that remains. Continue reading →